Background: Bowel resections have high morbidity and mortality rates and are becoming increasingly common in Australia. To reduce the burden on patients and the health system, measures for improving patient outcomes after resection must be investigated. One possible method for improving patient outcomes is prehabilitation with exercise. The aim of this systematic review is to determine the effect that exercise prehabilitation has on the functional status of patients undergoing colorectal resection. Method: Studies examining the effect of exercise prehabilitation on colorectal patients were gathered from online databases, including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and the Australia New Zealand clinical trial registry. The study design, population, intervention and outcomes were extracted from each study. Results: This systematic review included six studies involving a total of 415 patients. Three studies were randomized control trials and three were prospective cohort studies. Those that tested participants post-operatively found that the intervention group improved their 6-min walking distance more than the control group. This result was statistically significant in three studies. Similarly, two studies found that self-reported physical activity was significantly greater in the intervention group than in control groups. The rate of complications and length of hospital stay were not significantly different between intervention and control groups in any study. Conclusion: Prehabilitation significantly improves functional capacity and self-reported physical activity but its effect on complication rate was not significant in this review.© 2020 Royal Australasian College of Surgeons ANZ J Surg 90 (2020) 693-701ANZJSurg.com
Background: Groove pancreatitis (GP) is an underrecognised subtype of chronic pancreatitis, focally affecting the area between the duodenum and pancreatic head. It most commonly affects males between 40 and 50 years of age with a history of alcohol misuse. Patients most commonly complain of abdominal pain and vomiting. Due to its focal nature, it is a potentially surgically treatable form of chronic pancreatitis. We report results of patients surgically treated for groove pancreatitis followed by a literature review of patient outcomes post resection. Methods: A retrospective chart review of patients with histopathologically confirmed GP post-surgical resection at the Princess Alexandra Hospital and Greenslopes Private Hospital in Brisbane, Australia was conducted between 2013 and 2020. Diagnosis was confirmed histologically when Brunner gland hyperplasia and chronic inflammation/fibrosis were found within the pancreaticoduodenal interface. Preoperative and postoperative symptoms were analysed along with complications. Additionally, a systematic review on outcomes of patients undergoing pancreaticoduodenectomy (PD) for GP was performed from three databases. Results: Eight patients underwent surgery for GP. Elimination of preoperative symptoms was achieved in five of the eight patients. Major complications included one take back to theatre for pancreatic leak. Our literature review found complete resolution of pain and vomiting in 80% of GP patients after PD. Conclusion: Optimal management of GP begins with early recognition. Symptoms from GP are likely to respond well to surgical intervention. We advocate for aggressive surgical resection in a patient with a high index of suspicion for GP.
Objective: To assess medical students' perspective on medical history embedded into a pre-existing learning module. Design, Setting, and Participants: This study was performed in 2018 at the University of Tasmania; participants were medical students in year three of the Bachelor of Medicine Bachelor of Surgery course. This was a crosssectional study which used a mixed-method survey before and after a lecture series to assess medical students' perspectives on history of medicine. Intervention: Historical perspectives were incorporated into existing surgical pathology tutorials. Main outcome measures: Students completed a survey on medical history before and after the lecture series. The survey used both qualitative and quantitative measures to assess students' perception of the utility of medical history and how it was taught in this project. Results: In the initial questionnaire, students indicated they believed medical history would help make them better doctors and enhance their learning of pathology. In the final questionnaire, students agreed that learning medical history was important in becoming a doctor. Students enjoyed the content and found the integration of history and pathology beneficial to learning. Conclusion: This study demonstrates one method by which to increase medial history teaching without major alterations to an existing medical curriculum.
A 39-year-old female presented to a regional Australian hospital with diabetic ketoacidosis. Urine microscopy, culture and sensitivity (MCS) on arrival revealed 500 leukocytes and eventually culture grew pansensitive E. coli. Patient was transferred to ICU for ongoing care where she remained tachycardic despite resolution of her diabetic ketoacidosis. A CT pulmonary angiogram was performed which found a right lower lobe pulmonary embolus for which therapeutic anticoagulation was commenced. However, tachycardia persisted and the patient became febrile on day three of admission. A CT abdomen pelvis was performed which revealed left-sided emphysematous pyelonephritis secondary to a large staghorn calculus. Significant subcutaneous emphysema was also found in the left flank. A general surgery review was requested and the case was discussed with the urology team located at a tertiary centre. The patient was subsequently transferred to a tertiary hospital under urology where she underwent a left nephrectomy and wound debridement. This was complicated by colonic perforation and was repaired with an omental patch with a loop ileostomy formed. Patient underwent a total of six relooks and debridements before the wound was closed with a combination of delayed primary closure and split-thickness skin graft.
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